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A U.S. Customs and Border Protection rule is set to suspend the under-$800 de minimis exemption on Oct. 22, adding data and bond requirements to international mail, including personal medication shipments. Patients and lawmakers warn the change could delay or impede access to lower-cost drugs from Canada; the rule does not specifically target Canadian medicines, and its practical effects remain uncertain.
A U.S. Customs and Border Protection rule scheduled to take effect Oct. 22 will suspend a customs exemption for shipments valued under $800, potentially making it harder for millions of Americans to receive medicines ordered from Canada. The rule applies to international mail broadly, not Canadian drugs specifically, but patients and lawmakers say added data requirements and a bond could disrupt access to lower-cost prescriptions.
Under the change, the de minimis exemption will be suspended indefinitely. Medications mailed from outside the United States will face additional data requirements and a bond guarantee, along with fees and registration requirements for low-value shipments that previously entered duty-free. The stated aims include collecting tariffs and preventing illegal drugs from entering the country. The rule covers many types of goods, not only medicines.
An estimated 2.3 million Americans bought drugs abroad, according to a 2020 study published in JAMA Network Open. The precise impact of the new requirements on personal medication orders is not yet established. The report says the practical risks could include delays, refusals or greater difficulty getting medicines delivered.
Ken Hunter, executive director of the Campaign for Personal Prescription Importation, cited a study by his organization comparing 10 commonly imported medicines. It found a three-month supply of apixaban (Eliquis)—180 five-milligram pills—cost $565 through a Canadian mail-order pharmacy, compared with about $1,017 through Amazon’s pharmacy business and $1,029 through GoodRx. Those figures are the study’s cited prices, not a projection of what the customs rule will make the drugs cost.
Access to Lower-Cost Prescriptions
The rule could affect people who rely on cross-border mail to obtain medicines at prices they say are more affordable than U.S. alternatives. For those patients, the immediate concern is not necessarily a new retail price set by the rule, but whether orders can be processed and delivered under the added requirements. If shipments are delayed or rejected, patients may need to seek another source, potentially at a higher cost.
The change also creates a tension between the administration’s stated drug-price agenda and concerns about access. President Donald Trump has promoted most-favored-nation agreements with pharmaceutical companies and the TrumpRx discounted-drug website. But advocates argue those initiatives do not cover every medicine or every patient. The rule’s effects on individual patients, and whether alternative programs would meet their needs, are not yet clear.
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The Customs Exemption Change
The exemption at issue previously allowed packages worth less than $800 to pass through customs more easily. The scheduled suspension applies across international mail, including goods such as textiles and toys; it is not a policy written specifically for Canadian pharmacies or prescription drugs.
The administration has made prescription costs a public priority. Federal data from this summer showed U.S. prescription drug prices were 3.1% lower than a year earlier, the steepest year-over-year decline since 1963, according to the report. Trump has claimed credit for the decline, while experts cited by MedPage Today said factors beyond his policies likely contributed more. That broader price trend does not establish how the customs change will affect imported personal prescriptions.
Patients who order from Canada may face different practical options depending on where they live. Three Florida Republicans told the administration that their constituents cannot easily travel to Canada, while Florida’s federally authorized prescription importation initiative has stalled, according to the report.
“The Trump administration continues working to ensure Americans have access to low-cost pharmaceuticals across the board.”
— Allison Schuster, White House spokesperson
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How Personal Drug Orders Will Be Handled
It remains unclear how the new data, bond, fee and registration requirements will be applied to prescription medicines for personal use, or how often they might lead to delays or refusals. The report does not establish that Canadian shipments will be categorically barred or that prices will automatically rise because of the rule. Customs and Border Protection representatives did not respond to MedPage Today’s requests for comment.
The administration could drop the rule, change it or choose not to enforce it, according to the report. The available information also does not say whether the government will create a specific exception for personal prescriptions or provide a timeline for clarifying implementation.
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Decisions Before the October Deadline
The rule is scheduled to take effect Oct. 22. Before then, the administration could revise or pause it, but no such decision is confirmed in the source material. Lawmakers have asked federal officials to explain how affordable personal-use prescriptions will be treated, putting pressure on the administration to address that question.
Patients, pharmacies and importation advocates will be watching for official instructions on required shipment information, bonds and any exceptions. Until those details are available, the extent of disruption—and whether patients will need to change how they obtain medicines—remains uncertain.
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Key Questions
What changes on Oct. 22?
The under-$800 de minimis exemption is scheduled to be suspended indefinitely. International mail, including medication shipments, will face added data requirements and a bond guarantee, along with other requirements described in the report.
Does the rule specifically ban drugs from Canada?
No. The rule applies to international mail generally, rather than specifically targeting Canadian medicines. The report says it could nevertheless make Canadian drug orders harder to deliver.
Will Canadian prescription drugs automatically cost more?
The available information does not show that the rule will automatically increase drug prices. The main concerns raised are delivery delays, refusals and added difficulty; the effect on each shipment and patient is not yet clear.
How many Americans buy medicine from abroad?
A 2020 JAMA Network Open study estimated that roughly 2.3 million Americans bought drugs abroad. That figure is an estimate from the study and does not measure how many shipments the new rule will affect.
Could the rule change before it takes effect?
Yes. The report says the administration could drop, alter or decline to enforce the rule. No change or personal-prescription exception is confirmed in the source material.
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